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General NPI Number Information
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NPI Number | 1154314904
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Entity Type | Individual
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Provider Name | JUAN M FUKUDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 02/04/2011
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Provider Practice Location Address
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Address Line | 4600 AMBASSADOR CAFFERY PKWY PEDIATRIC EMERGENCY MEDICINE
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City | LAFAYETTE
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State | LA
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Zip | 70508-6902
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Country | US
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Telephone | 337-521-9027
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Fax | 337-521-9164
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Provider Business Mailing Address
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Address Line | 4600 AMBASSADOR CAFFERY PKWY PEDIATRIC EMERGENCY MEDICINE
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City | LAFAYETTE
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State | LA
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Zip | 70508-6902
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Country | US
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Telephone | 337-521-9027
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Fax | 337-521-9164
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14374R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 14374R
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 14374R
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License Number State | LA
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